This proposal relates to the AHRQ research priority on "Developing strategies to incorporate individuals' values and equity considerations into cost-effectiveness analyses". To inform this priority, it is necessary to understand what people value in terms of equity. We therefore propose the following specific aims: 1) Identify what members of a group model HMO interpret as equity in health and health care; 2) Assess the efficiency and equity trade-offs that these members are willing to make within their own health plan; 3) Compare and contrast preferences for equity expressed by US HMO members with those expressed by UK citizens regarding their National Health Service; 4) Develop measurement tools and analysis guidelines for incorporating equity preferences into formal cost-effectiveness evaluations. We will build on work currently being performed at the University of York, UK, and will involve two researchers from the York team (the PI and the qualitative methodologist) as consultants. We will modify a self-administered equity-efficiency trade-off instrument that was developed and successfully utilized by the UK team, perspective and focus for this proposal is US managed care, so modifications will center on creating an instrument with relevance to that population. The study will involve 1) 5 focus groups of 4-6 people, 2) cognitive pre-testing of the instrument with 10- 15 people, 3) 2,000 pilot questionnaires administered to a sample of adult members of the study HMO, and 4) dissemination activities. The focus groups will enable us to probe notions of equity as managed care enrollees perceive it within their health plan, whether or not participants, believe Nulty ought be addressed in that forum, and the particular equity issues that are seen to be of greatest importance. Using information from the focus groups we will modify the instrument, and then cognitively pre-test the modified instrument to ascertain its usability for self-administration. We expect a response rate to the survey of about 50%. This study will provide a first glimpse of the issue of equity from the perspective of closed panel managed care, one form of managed health care organization covering a large portion of the US population. We anticipate that this work will be of great importance to policy makers, both governmental and within managed care plans, and to researchers wrestling with the incorporation of equity into cost-effectiveness analysis.